Purpose: Does manikin fidelity affect learning outcomes in neonatal resuscitation simulation? Description: This experimental design accessed and randomly assigned health care professionals (HCP) (N=60), who completed Neonatal Resuscitation Program (NRP) recertification in a simulation lab. The experimental group used a high-fidelity manikin. The control group recertified using a low-fidelity manikin. Dependant variables included learning outcomes of confidence, skill performance, and knowledge. These were measured using the newly developed Neonatal Resuscitation Confidence Tool (NRCT), Megacode Assessment, and NRP written exam. Both groups underwent the same simulated resuscitation scenario. Outcome: A significant increase in confidence with simulation was found (p<.001). HCPs using the high-fidelity simulator did not have a significant increased level of confidence, knowledge or skill performance compared to using the low-fidelity simulator. However, there was a significant increase in confidence with repeated NRP courses (p=.003). Implications: The use of simulation for NRP is important to increase capability with increased practice intervals.